Summary
The Eleventh Circuit affirmed the district court's judgment concerning coverage for high-dose chemotherapy and autologous peripheral stem cell rescue treatment for ovarian cancer. The court held that the insurance policy's exclusion for services relating to such treatment applied to the treatment itself because the exclusion's plain meaning covered the recommended treatment for non-germ-cell ovarian cancer.
Topics
Practice areas
Questions Presented
- Whether the policy exclusion for services or supplies relating to treatment involving high-dose chemotherapy and autologous peripheral stem-cell rescue excluded the HDC/PSCR treatment itself for non-germ-cell ovarian cancer.
Holdings
- The plain meaning of the policy exclusion eliminates coverage for the recommended high-dose chemotherapy and peripheral stem-cell rescue treatment for Mire's non-germ-cell ovarian cancer.
Key quotations
“We conclude that the plain meaning of the exclusion eliminates coverage for this suggested treatment for appellant's non-germ cell ovarian cancer.”
Factual background
Carol Mire was being treated for ovarian cancer and sought high-dose chemotherapy with peripheral stem-cell rescue, a treatment involving chemotherapy, stem-cell collection and storage, reinfusion, and hospitalization. Her health insurance policy excluded services involving high-dose chemotherapy and specified forms of autologous bone marrow or stem-cell rescue for diseases other than those listed, and ovarian cancer was not among the listed diseases.
Procedural history
The appeal came from the United States District Court for the Southern District of Florida, which entered judgment in favor of Blue Cross/Blue Shield of Florida. The Eleventh Circuit expedited the appeal because of Mire's serious medical condition and affirmed the district court's judgment.